Provider Demographics
NPI:1790995454
Name:DEIDRA RONDENO DDS, PC
Entity Type:Organization
Organization Name:DEIDRA RONDENO DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDENO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-942-0086
Mailing Address - Street 1:52 EXECUTIVE PARK SOUTH NE
Mailing Address - Street 2:SUITE 5203
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2217
Mailing Address - Country:US
Mailing Address - Phone:404-942-0086
Mailing Address - Fax:208-955-2434
Practice Address - Street 1:52 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:SUITE 5203
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2217
Practice Address - Country:US
Practice Address - Phone:404-942-0086
Practice Address - Fax:208-955-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty